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Trends in graduate medical education in North Carolina : challenges and next steps

Trends in graduate medical education in North Carolina challenges and next steps - Page 1

Trends in Graduate Medical
Education in North Carolina:
Challenges and Next Steps
Erin Fraher
Julie Spero
Jessica Lyons
Helen Newton
March 2013
Introduction
Anticipating an increase in the demand for physician
services in the near future, North Carolina’s two public
medical schools recently increased their enrollment. In
2010, The University of North Carolina began to expand
their entering classes from 160 entering positions to 180
positions by 2012. UNC also added regional placements
in Charlotte and Asheville for 3rd-year and 4th-year
students. During the same period, the Brody School of
Medicine at East Carolina University expanded from
73 to 80 students per year, with 3rd and 4th-year students
training at satellite clinics in the eastern part of the state.
Campbell University, a private institution, is building a
new school of osteopathic medicine that will admit its
first class of 150 students in September 2013.
After graduating from medical school, physicians
must complete additional training called “graduate
medical education” (GME) to become licensed to practice.
Physicians in GME are commonly known as “residents,”
and these residencies last anywhere from three to seven
years and usually focus on a particular medical specialty,
such as pediatrics or orthopedic surgery.
The largest single source of funding for the costs
of training residents in North Carolina comes from
Medicare. Other funding sources include Medicaid,
hospital revenues and direct state appropriations.
Recent efforts to expand the number of publicly-funded
residency slots in North Carolina have not been
successful, primarily due to the high cost. Nationally,
cost is estimated to average about $143,000 per resident
per year,1 but costs vary widely depending on geography,
institution, and medical specialty. Because of the state’s
current fiscal constraints, future attempts to expand
residency training with state appropriations will need
to demonstrate that investments of public funds return
value to the state either by resolving workforce needs in
shortage specialties and underserved communities or by
helping small hospitals survive.
Graduate Medical Education represents a significant
economic investment of both state and federal dollars,
yet there is little accountability for this spending. This
factsheet outlines what we know about GME in North
Carolina. The analyses investigate whether physicians
remain in-state after finishing residency training and
whether residency training programs are producing
physicians in needed specialties who practice in the
communities where they are most needed. The report
concludes with some recommendations about how the
state might develop a more rational, transparent and
accountable system that ensures that public investments
in residency training are meeting the health workforce
needs of North Carolina.
Methodology & Data
Data in this report were compiled from multiple
sources. Information about the North Carolina physician
workforce was derived from the North Carolina Medical
Board’s (NCMB) initial licensure and annual renewal
forms, completed by all physicians licensed to practice
in the state. Descriptive data from the NCMB system are
housed at the North Carolina Health Professions Data
System (HPDS) at the Cecil G. Sheps (Sheps) Center
for Health Services Research at the University of North
Carolina at Chapel Hill. Data on numbers of residents
Program on Health Workforce Research & Policy
The Cecil G. Sheps Center for Health Services Research
The University of North Carolina at Chapel Hill
Campus Box 7590 • 725 Martin Luther King Jr. Blvd. • Chapel Hill, NC 27599-7590
http://www.healthworkforce.unc.edu • http://www.shepscenter.unc.edu/hp • nchp@unc.edu • (919) 966-7112
Program on Health Workforce Research & Policy, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill

Trends in Graduate Medical
Education in North Carolina:
Challenges and Next Steps
Erin Fraher
Julie Spero
Jessica Lyons
Helen Newton
March 2013
Introduction
Anticipating an increase in the demand for physician
services in the near future, North Carolina’s two public
medical schools recently increased their enrollment. In
2010, The University of North Carolina began to expand
their entering classes from 160 entering positions to 180
positions by 2012. UNC also added regional placements
in Charlotte and Asheville for 3rd-year and 4th-year
students. During the same period, the Brody School of
Medicine at East Carolina University expanded from
73 to 80 students per year, with 3rd and 4th-year students
training at satellite clinics in the eastern part of the state.
Campbell University, a private institution, is building a
new school of osteopathic medicine that will admit its
first class of 150 students in September 2013.
After graduating from medical school, physicians
must complete additional training called “graduate
medical education” (GME) to become licensed to practice.
Physicians in GME are commonly known as “residents,”
and these residencies last anywhere from three to seven
years and usually focus on a particular medical specialty,
such as pediatrics or orthopedic surgery.
The largest single source of funding for the costs
of training residents in North Carolina comes from
Medicare. Other funding sources include Medicaid,
hospital revenues and direct state appropriations.
Recent efforts to expand the number of publicly-funded
residency slots in North Carolina have not been
successful, primarily due to the high cost. Nationally,
cost is estimated to average about $143,000 per resident
per year,1 but costs vary widely depending on geography,
institution, and medical specialty. Because of the state’s
current fiscal constraints, future attempts to expand
residency training with state appropriations will need
to demonstrate that investments of public funds return
value to the state either by resolving workforce needs in
shortage specialties and underserved communities or by
helping small hospitals survive.
Graduate Medical Education represents a significant
economic investment of both state and federal dollars,
yet there is little accountability for this spending. This
factsheet outlines what we know about GME in North
Carolina. The analyses investigate whether physicians
remain in-state after finishing residency training and
whether residency training programs are producing
physicians in needed specialties who practice in the
communities where they are most needed. The report
concludes with some recommendations about how the
state might develop a more rational, transparent and
accountable system that ensures that public investments
in residency training are meeting the health workforce
needs of North Carolina.
Methodology & Data
Data in this report were compiled from multiple
sources. Information about the North Carolina physician
workforce was derived from the North Carolina Medical
Board’s (NCMB) initial licensure and annual renewal
forms, completed by all physicians licensed to practice
in the state. Descriptive data from the NCMB system are
housed at the North Carolina Health Professions Data
System (HPDS) at the Cecil G. Sheps (Sheps) Center
for Health Services Research at the University of North
Carolina at Chapel Hill. Data on numbers of residents
Program on Health Workforce Research & Policy
The Cecil G. Sheps Center for Health Services Research
The University of North Carolina at Chapel Hill
Campus Box 7590 • 725 Martin Luther King Jr. Blvd. • Chapel Hill, NC 27599-7590
http://www.healthworkforce.unc.edu • http://www.shepscenter.unc.edu/hp • nchp@unc.edu • (919) 966-7112
Program on Health Workforce Research & Policy, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill